AFRM eBulletin – 19 October 2018

Dr Patrick Arulanandam on winning the 2017 Adrian Paul Prize

It was an honour to receive the Adrian Paul Prize, in recognition of research I completed as a trainee at Canberra Hospital, and presented at the 2017 Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ) annual scientific conference. 

The research consisted of a retrospective case series of patients who received inpatient rehabilitation while undergoing chemotherapy. I found that the average length of stay, FIM gain and rates of discharge home were similar to the general rehabilitation cohort of that ward. A qualitative component of the study, based on chart review, suggested that ease of access to blood products and oncology team reviews were important in minimising acute transfers. This implies that rehabilitation units which are co-located within acute hospitals may be better able to serve this patient group compared to standalone units, unless the latter also use an in-reach model of care.

I was gently nudged towards this topic by my then term supervisor, after reviewing a newly referred patient with metastatic cancer. Premorbidly well, middle-aged, and significantly deconditioned, he would likely need several weeks of inpatient rehab, but would continue to receive intravenous chemotherapy during this time. We were both a little skeptical about the role of inpatient rehab in this setting. Would he tolerate twice-daily therapy? Would he spend more time in the chemo suite than the gym? Would it be better to wait for the chemo to finish before starting rehab? On the other hand, we could recall similar patients who had done surprisingly well. 

One important lesson I learned from my project is that research is most satisfying when it is driven by real-world clinical encounters that are meaningful to the researcher, like the above discussion with my supervisor. Although there are advantages to joining an established project (convenience, funding, expertise etc), there’s a unique satisfaction to owning your own research question and developing a methodology from the ground up. It takes more effort, but you’ll be more motivated, and that can make all the difference.

The flipside of this, for trainees, is being realistic about what is achievable within a six-month term. Retrospective studies based on existing data collections are a good option, partly because low/negligible risk ethics applications have a quicker turnover, and you don’t have to agonise over patient recruitment (which always takes longer than you plan). As many hospitals move towards electronic medical records, opportunities for high quality retrospective studies should increase in the years to come.
     
It’s also worth considering that there is no stark dividing line between quality improvement (QI) projects and research. What begins as QI can turn into something more substantive and lead to publishable findings. The good news is that rehab medicine, by its nature as a complex multidisciplinary process, abounds with fruitful QI ideas. 

I’d encourage all trainees to set themselves a research-related goal during their training: present at least one poster at an RMSANZ annual scientific meeting, or publish at least one paper (or do both). This is achievable. Module three provides a great opportunity to work towards this, and perhaps win the next Adrian Paul Prize.

Dr Patrick Arulanandam 
AFRM Fellow 

A message from your President

25th AFRM anniversary edition of Rhaia and AOCPMR2018 in Auckland

I recently took over as AFRM representative on College Council and attended my first meeting in Melbourne. The College Board established the College Council in 2015 to act as its peak advisory body on strategic and cross-College issues. As a senior advisory body, the Council makes recommendations to the Board by consensus. More information can be found on the RACP website. College Council is likely to be increasingly important to the AFRM now that the Board re-structure has been completed and the Faculty is not directly represented on the Board. One of the issues discussed was the establishment of the College Council Executive and it is planned that there will be at least one Faculty representative on the Executive.

While in Melbourne I also had the pleasure of attending my first Convocation Ceremony as Faculty President. It was an honour and privilege to be able to hand their testamurs to our newest AFRM Fellows and it also gave me the opportunity to reflect on when I was in that same position myself. To me, this seems both a very long time ago (1997) but then again, only yesterday: I congratulate all of our new Fellows and hope that they have rich and fulfilling careers in rehabilitation medicine.

The Faculty Office is currently in the process of compiling a special edition of Rhaia to celebrate the 25th Anniversary of the Faculty which will be published in early December. If you would like to submit a short article for consideration, please send it to afrm@racp.edu.au by Friday, 2 November. We are also interested in copies of very early editions of Rhaia if anyone has kept them. 

If you have not already registered I would encourage you get organised and attend the 6th Asia-Oceanian Conference of Physica & Rehabilitation Medicine (AOCPMR) – NORTH TO SOUTH, EAST TO WEST http://aocprm2018.com/aocprm18) which is combined with the Rehabilitation Medicine Society of Australia and New Zealand's (RMSANZ) third Annual Scientific Meeting, 21 to 24 November 2018 at SkyCity Auckland, New Zealand. The program looks very informative and I hope to see you there.

All the best,
Professor Tim Geraghty 
President, Faculty of Rehabilitation Medicine

Congratulations to Professor Fary Khan who was awarded the Sidney Licht Award

Professor Fary Khan was awarded the 2018 Sidney Licht Lectureship Award by the International Society of Physical & Rehabilitation Medicine (ISPRM) at their Annual Scientific Congress in Paris on 12 July 2018. This prestigious international award is given to rehabilitation physicians who have made a significant contribution to the advancement of international physical and rehabilitation medicine. The nomination is endorsed by 61 international rehabilitation medicine societies in all World Health Organization (WHO) regions. 

Professor Khan received the award for her consistent contribution to building evidence-based practices in rehabilitation medicine (over 350 scientific publications), promoting community-based rehabilitation programs and various models for health service delivery, developing measurement and clinical outcome evaluation, innovations in disability-related healthcare, building global capacity in rehabilitation medicine and developing disaster relief for rehabilitation services.

She is currently the Director of Rehabilitation at the Royal Melbourne Hospital and the University of Melbourne. She is also the Australian Representative for the ISPRM and the Asia-Oceania Society of Physical and Medical Rehabilitation. She was independent elected member for Rehabilitation Medicine for Asia and Oceania Region for the past four years. She is the Chair of ISPRM Disaster Rehabilitation Committee and Disaster Rehabilitation Special Interest Group of the Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ), Executive member of the WHO Liaison Committee for Capacity building, the Women’s Health Task Force and Cancer Rehabilitation Network ISPRM. Her work in refugee healthcare and promoting rehabilitation services in low income countries in the region is highly regarded.
 

Lincoln James Leonard Jansz (26 April 1964 to 15 Sept 2018) – Beloved Husband, Father, Friend, Colleague, Physician, Educator, Wordsmith

Lincoln, the younger of two sons, was born in Sri Lanka. He lived with his paternal grandmother in Lincolnshire from an early age until he was 12 after which he returned to Sri Lanka to complete his schooling. He earned his undergraduate Medical Degree in Maulana Azad Medical College in New Delhi. In 2006 he moved to New Zealand with his wife Yawane. After a brief hiatus from medicine Lincoln found his passion in spinal cord injury rehabilitation medicine at Burwood Spinal Unit. It was here that he trained and became a Fellow of the Australasian Faculty of Rehabilitation Medicine in 2016. 

Lincoln was a dedicated and enthusiastic student and teacher. His innate ability to learn and recall (apparently, he learned all Churchill's speeches by heart) and his incredible vocabulary were well acknowledged and often envied. His passion for teaching and for ensuring excellence in New Zealand’s future AFRM Fellows was evidenced even in his final days as he continued to participate in AFRM teaching at the spinal unit and from home. 

Lincoln was a private person, but a friend to many. Colleagues in Christchurch have said he would often be found talking with various support staff at Burwood and that he made everyone feel valued. 

He was a firm believer of putting the patient first and advocating for their cause. 
His patients knew he truly was doing what was best for them. He was respected, trusted and loved. Former patients and family members often made the effort of returning to Burwood to thank him for his care and kindness. 

His commitment to his family and to his children was so strong that he never considered leaving Christchurch, even for a limited time to enhance his training. The dedication to his wife and children was what drove his determination to live and thrive as long as he could.

Lincoln fought the good fight courageously and with dignity until his time came. All who knew him recognised the incredibly intelligent, caring, dedicated and unique man that he was. He was a beloved friend, colleague, advocate, and educator whose passing has left a large void in our lives. Although Lincoln will be missed, his legacy will live on. 

Lincoln leaves behind his wife Julianne and sons Benig and Milan.

Moe mai ra e te hoa, haere atu i roto i te aroha me te rangimarie.

Dr Cynthia Bennett 
Chair, NZ Regional Committee 

Important Information for NSW Lecture Series and Bi-National Training Program

AFRM trainees should note that November’s NSW Lecture Series and Bi-National Training Program sessions will be held in the Jamieson Room on level 5, 70 Phillip Street. 

Important study of ageing and dementia in people with intellectual disability

People with intellectual disability who are over 40 years old can take part in a study about ageing run through 3DN at UNSW. Carers can also be involved. An easy-read flyer is available. 

The research team request that clinicians and service providers please pass this information on to potential participants.

For more information please call Liz Evans or Rebecca Daly on +61 2 9931 9160. 

ANZHFR Newsletter – September 2018

The third Australian & New Zealand Hip Fracture Registry (ANZHFR) newsletter for 2018 provides an update on the considerable progress being made on both sides of the Tasman. Patient numbers continue to increase, and it is exciting to be able to advise that the combined registries have a total of 25,792 records from 70 hospitals: 20,078 from Australia and 5,714 from New Zealand. This edition of the newsletter includes an update on participation and the flagging of changes to the Data Dictionary for 2019.

Read the newsletter

AFRM Expressions of Interest – Regional Committees

Expressions of Interest are being sought for several opportunities within AFRM Regional Committees.

The AFRM Regional Committee has been established to:

  • advise the Faculty Council on matters relevant to the Faculty in their region
  • promote rehabilitation medicine in their region
  • respond to new and emerging rehabilitation medicine issues relevant to the Faculty as they arise provided the issue is approved by the Faculty President or Faculty Council prior to work commencing
  • work with other relevant appropriate College bodies and staff in relation to training and continual professional development and contributing to policy and advocacy matters
  • the activities of the Committee must be consistent with the College’s Strategic Directions document or any successor document.

For further information please visit: 
www.racp.edu.au/expressions-of-interest/afrm-nsw-regional-committee
www.racp.edu.au/expressions-of-interest/afrm-wa-regional-committee

Strengthening CPD

Following the recent release of the Medical Board of Australia’s Professional Performance Framework, a new 2019 MyCPD Framework comes into effect in November 2018.

The simplified Framework strengthens CPD by engaging Fellows in a range of CPD activities from three categories:

  • Educational activities
  • Reviewing performance
  • Measuring outcomes

It is likely you are already completing formal or informal activities that can be claimed in these categories.

To help you understand the changes, we’ve put together a list of common questions and answers, that explain what the changes mean for you and why they’ve been made. You can also download the 2019 Framework online.

Read more

Rebooting CPD podcasts out now

The origins of regulatory changes on the CPD horizon and Fellows first-hand experience of the 'strengthened CPD' approach are the focus of two new Pomegranate Health episodes.

Listen now

Expressions of Interest to the RACP Clinical Ethics Support Working Party

Expressions of Interest are currently being sought for two members (including one trainee member) to join the new Clinical Ethics Support Working Party. The Working Party will also comprise a consumer member and six members of the College Ethics Committee.

Please complete the EOI form and forward with your CV to ethics@racp.edu.au by Thursday, 1 November 2018.

For more information please visit the EOI webpage.

If you have any enquiries about the Clinical Ethics Support Working Party, please email ethics@racp.edu.au.

Evolve Updates 

Handle antibiotics with care
As part of World Antibiotic Awareness Week (12 to 18 November 2018), RACP Evolve is inviting trainees and Fellows to become Evolve Clinical Champions by pledging their support to reduce unnecessary prescribing of antibiotics. Find out how you can pledge your support by contacting evolve@racp.edu.au. You can also visit the Evolve website for more information

Research
Are you currently planning to undertake research as part of your Advanced Training? The Evolve recommendations offer an opportunity to undertake research in low-value care in specific health priority topics, such as bronchiolitis, antimicrobial stewardship, polypharmacy, high-risk medications and deprescribing.

Bronchiolitis clinical initiative
NSW Health and the Agency for Clinical Innovation (ACI) are currently undertaking a program that aims to address clinical variation in inpatient and emergency department management of bronchiolitis in NSW. It also aims to improve adherence to clinical guidelines and reduce potential harm from unnecessary testing and treatment.

Find out more about the Bronchiolitis Clinical Initiative and other low-value care research opportunities in your specialty by contacting evolve@racp.edu.au or go to the Evolve website.

Conference opportunities
The RACP has presented on Evolve at:

  • RACP Congress
  • Choosing Wisely Australia National Meeting
  • National Medicines Symposium
  • Australian and New Zealand Society of Geriatric Medicine (ANZSGM),
  • Society of Obstetric Medicine of Australia and New Zealand (SOMANZ)
  • Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW).

In November, we are looking forward to attending the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists (ASCEPT) in Adelaide. 

All Specialty Societies can request the RACP attend their conference to present on Evolve and low-value care and/or host an exhibition booth. For more information and to express interest in RACP attending your conference in 2019, contact evolve@racp.edu.au.  

Managing GORD with PPIs
RACP Evolve supports the NPS MedicineWise education program, which aims to reduce or stop Proton Pump Inhibitor (PPI) treatment when Gastro-oesophageal reflux disease (GORD) symptoms are well controlled. Find out more by visiting the NPS MedicineWise website.

How can you raise the reduction of PPI treatment with a patient? Watch RACP President Associate Professor Mark Lane include the GESA Evolve recommendation in a difficult conversation with a patient on the RACP YouTube channel.  

RACP survey of Fellows' experience with Health Care Homes 

Stage one of the Australian Government Health Care Homes (HCH) trial commenced in 2017 and will continue until November 2019.

If you work in one of the trial Primary Health Networks of the Department of Health you may receive an invitation shortly from the College to complete this survey. However, any Fellows with experience of or patients in a Health Care Home may respond. This is part of the College’s high profile work on Integrated Care, developing a Model of Integrated Care for patients with multiple chronic conditions. Fellows are strongly encouraged to complete this brief online survey.

The brief online survey will be open until 30 November 2018.

Any questions may be sent to racpconsult@racp.edu.au

Alliance strengthened

A new Memorandum of Understanding (MoU) signed between medical colleges in Australia, New Zealand and Canada is taking their collaborative relationship to the next level by formalising a vision, mission and objectives for future engagement.

Representatives from the Tri-nation Alliance – which comprises of the RACP, Royal College of Physicians and Surgeons of Canada, Royal Australian and New Zealand College of Psychiatrists, Royal Australasian College of Surgeons and Australian and New Zealand College of Anaesthetists – signed the MoU in Canada on Tuesday, 16 October.

Read more

Kids off Nauru Campaign 

The RACP has signed on to the Kids Off Nauru campaign, urging the Australian Parliament to support the immediate transfer of all refugee and asylum seeker children and their families from Nauru to Australia for health reasons. Children and their families need an urgent assessment in a specialist tertiary level child health facility, where their medical, developmental and social-emotional (psychiatric) health can be assessed and treated in accordance with specialist recommendations. 

This campaign was the most successful social media campaign the RACP has conducted, the hash tag trended on twitter and reached over 200,000 people across social media channels. This is based on RACP posts alone and doesn’t include other medical colleges.

Your voice is being heard, physicians are respected members of the community and governments listen to your messages – keep the campaign going and get active on social media. Use the social media kit and poster to join the RACP's calls for #doctorsforasylumseekers. Please also sign the doctors make change petition.

We are encouraging members to write to or meet with your local Member of Parliament (MP) to advocate on this issue. Please use the template letter and Refugee and Asylum Seeker Health Position Statement when writing to your MP. The Tips for meeting with MPs and RACP Advocacy Framework can assist with productive meetings. If you do meet with your local MP, please let us know at policy@racp.edu.au.

Expressions of Interest

Check the Expressions of Interest page at any time, to find out if there are any opportunities that are of benefit to you.

Trainee events

The Royal Australasian College of Physicians publishes notices of events and courses as a service to members. Such publication does not constitute endorsement or mandating of any such events or courses. 

Go to the events list at any time to see what events are coming up.
Bi-National Training Program (BNTP) 

The AFRM conducts the BNTP on the last Wednesday of every month from February to November. These training sessions are broadcast across Australia and New Zealand. The BNTP sessions use Zoom conferencing to provide trainees with rehabilitation medicine knowledge and information. These sessions are not intended to prepare trainees for the AFRM Fellowship Examinations. 

View event listings

To join the webinar on the day, follow this link to Zoom Software. It is important to log on early and ensure that you turn your webcam off before you join the webinar. Due to the nature of the recordings, if you connect via videoconference, you will appear on the screen. Should you do so, we will assume automatic consent to be part of the recording.

See previous program video and presentation documents.

NSW Lecture Series – Wednesday and Saturday sessions

The AFRM conducts the NSW Lecture Series on the last Wednesday of every month from February to November. These training sessions are recorded and material is available online after each session. Trainees will require their MIN and password to access this material.

The NSW Branch runs monthly training sessions on various Saturdays throughout the first half of each year. These sessions give trainees practice in the Objective Structured Clinical Exam (OSCE) sessions in preparation for their Fellowship exams.

These sessions are held on a Saturday morning at various hospital locations and led by different AFRM Fellows. Unlike the BNTP and NSW Training, which take place on the last Wednesday of each month, there is no pattern to these events.

View session dates

See previous session video and presentation documents

AFRM contact details 

Member enquiries
Phone: (AUS) 1300 69 7227
Phone: (NZ) 0508 69 7227
Email: memberservices@racp.edu.au 

AFRM Faculty enquiries (including Council and committees):
Anastasia Barabash, Executive Officer, AFRM
Phone: +61 2 8076 6315
Email: afrm@racp.edu.au

AFRM Education and Training enquiries:
Name: Lia Iliou, Education Officer
Phone: +61 2 8076 6350
Email: rehab@racp.edu.au  

AFRM Examination enquiries:
Name: Irene Atsiaris, Examination Coordinator 
Phone: +61 2 9256 5422
Email: examinations@racp.edu.au  

AFRM training site accreditation enquiries:
Name: Sonia Tao, Education Officer
Phone: +61 8247 6233
Email: accreditation@racp.edu.au 
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